From Bolus of propofol to Automation in Intravenous Anaesthesia: A Historical Perspective with Key Contributions from Belgian Research

Abstract

Intravenous anaesthesia has undergone a profound transformation over the past five decades, evolving from intermittent bolus administration to highly sophisticated automated delivery systems. Propofol, introduced in the 1980s, enabled continuous infusion techniques and later the development of target-controlled infusion (TCI), fundamentally changing anaesthetic practice. Advances in pharmacokinetic–pharmacodynamic modelling, many of which involved key contributions from Belgian research groups, facilitated increasingly precise drug delivery. More recently, closed-loop systems (CLS) integrating physiological feedback such as electroencephalographic or hemodynamic variables have demonstrated improved control of anaesthetic depth and cardiovascular stability compared with manual titration. Despite these advances and the wide clinical use of TCI nowadays, widespread clinical adoption of full closed-loop systems remains limited, and robust evidence demonstrating improved patient-centred outcomes is still lacking. This review traces the evolution of intravenous anaesthesia, highlights key scientific contributions, including those from Belgian teams, and critically appraises the current evidence supporting automation and artificial intelligence in perioperative medicine. While automation offers clear advantages in standardization and workload reduction, its future integration will depend on demonstration of clinical benefit, usability, and regulatory acceptance.